In the spirit of World Breastfeeding Week 2022

This year, the theme for World Breastfeeding Week 2022 is Step up for Breastfeeding - strengthening the capacity of actors who protect, promote and support breastfeeding across different levels of society. Here at Possums & Co., we have been dedicated to this cause for the past ten years; decades longer, in fact, considering the life work of our CEO and Medical Director, Dr Pamela Douglas. We recognise that to do so requires a holistic, multifaceted approach. Breastfeeding is not a simple concept and breastfeeding problems are not resolved with simplistic interventions.

Neuroprotective Developmental Care (‘NDC’, or the Possums Programs) offers a unique and comprehensive approach to infant care that considers (and addresses, through clinically effective tools) how breastfeeding is fundamental to the domains of maternal mood, infant cry-fuss problems, and sleep (1). NDC draws on evidence from the fields of neuroscience and medical science, lactation and sleep science, the psychology of attachment, and evolutionary medicine, as well as incorporating a modern form of Cognitive Behavioural Therapy - Acceptance and Commitment Therapy, or ACT (2-5).

Through our training and education programs we have had the privilege of working with hundreds of health professionals who are key actors - right at the front line, directly impacting the lives of mums and bubs through breastfeeding support. Our growing network of NDC practitioners comprises General Practitioners, Midwives, Nurses, International Board Certified Lactation Consultants, Psychologists, Speech Pathologists, and other allied health providers. What we collectively understand is that the power of the work we do at an individual level is in listening to the woman in front of us, making sense of many interacting facets of breastfeeding problems, and empowering her with the information and support she needs to establish and continue her unique breastfeeding journey.

Our wonderful team of health professionals are supporting women to breastfeed successfully through the breastfeeding domain of Neuroprotective Developmental Care; an evidence-based, systematic approach developed out of many years of work, including ultrasound and vacuum studies of breastfeeding mother-baby pairs (6-11). Our breastfeeding work integrates the gestalt method of fit and hold, which helps with many common problems (including fussing at the breast, difficulty coming onto the breast, back arching, maternal nipple pain, marathon feeds, excessive night waking, and poor weight gain) and empowers women to experiment with a range of specific strategies to address problems. The NDC breastfeeding domain also draws from the new mechanobiological models of lactation-related breast inflammation and nipple pain to provide evidence-based support. We know from both the research (6-11) and extensive clinical experience, the positive impact of supporting women to apply these techniques.

Importantly, though, we also understand that in the education and tools delivered to both health professionals and parents (through our online programs and in our Possums clinic) we must also consider what is happening with mum and bub’s sleep, determine if our little ones are crying and fussing excessively, and seek to understand the impact a mother’s breastfeeding journey has on her overall mental health and wellbeing.

For example, breastfeeding support is at the heart of our intervention for crying and fussing babies. Our five-domain approach to managing unsettled infant behaviour includes addressing and managing breastfeeding problems – positional instability, conditioned dialling up with feeds and poor satiety (12-14). Inevitably, when breastfeeding is successful, a baby becomes ‘dialled down’ – resulting in more joy for mothers, babies, and families more broadly. And of course, the topic of breastfeeding has an important place in our Possums Baby and Toddler Sleep Program. For example, we often need to sensitively address parents’ concerns about their babies falling asleep at the end of a breastfeed. This concept of the feed – play – sleep cycle (arising from First Wave Behavioural approaches to infant sleep) unhelpfully implies that breastfeeding to sleep can form associations or habits that disrupt sleep and settling.

Finally, we cannot ignore the relationship between breastfeeding and postpartum mental health and wellbeing (15). Breastfeeding problems can result in profound distress for women; for some women, perceived failure to breastfeed can be a trigger for postnatal depression (16). On the other hand, breastfeeding can have a protective effect for postpartum depression, but only if it is going well (17). Therefore, for mothers who want to feed, supporting them to optimise success is vital for mental health and wellbeing, and again, is at the core of our NDC work – particularly with the integration of ACT.

I would like to end this blog post by acknowledging the incredible mothers who, despite the many challenges, continue to breastfeed their babes. I would also like to thank our wonderful health professionals who go above and beyond to provide compassionate, non-judgmental support for women during their breastfeeding journey - I for one, am continually impressed and inspired by the work you do! And last, but certainly not least, a note of appreciation for every member of our little not-for-profit organisation; we commence our workdays with pride and enthusiasm because we are genuinely dedicated to the cause of helping to grow joy in early life!

Want to know more about the work we are doing at Possums & Co.?

• If you are a health professional interested in upskilling in the Possums Programs, you can learn more about our NDC Accreditation pathway here.
• For parents wanting to access our educational programs and tools or support from one of our NDC Accredited practitioner via our Possums Clinic, here are some helpful links:
  • Milk & Moon
  • The Possums Clinic
  • Free resources:
    • Blogs
    • Videos
    • Podcasts
    • ACT mental health strategies

References

1.         Crawford E, Whittingham K, Pallett E, Douglas P, Creedy D. An evaluation of Neuroprotective Developmental Care (NDC/Possums Programs) in the first 12 months of life. Maternal and Child Health Journal. 2022:26(1):110-123.

2.         Whittingham K, Douglas P. Optimising parent-infant sleep in the first 6 months: a new paradigm. Infant Mental Health Journal. 2014;35:614-623.

3.         Douglas P, Miller Y, Bucetti A, Hill PS, Creedy D. Preliminary evaluation of a primary care intervention for cry-fuss behaviours in the first three to four months of life ("The Possums Approach"): effects on cry-fuss behaviours and maternal mood. Australian Journal of Primary Health. 2013; 18:332-338

4.         Douglas PS, Hill PS. A neurobiological model for cry-fuss problems in the first three to four months of life. Med Hypotheses. 2013;81:816-822

5.         Whittingham K, Douglas, Pamela S. 'Possums': building contextual behavioural science into an innovative evidence-based approach to parenting support in early life. In: Kirkaldy B, editor. Psychotherapy in parenthood and beyond. Turin: Edizioni Minerva Medica; 2016. p. 43-56.

6.         Douglas PS, Keogh R. Gestalt breastfeeding: helping mothers and infants optimise positional stability and intra-oral breast tissue volume for effective, pain-free milk transfer. Journal of Human Lactation. 2017;33(3):509–518.

7.         Douglas PS, Perrella SL, Geddes DT. A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series. BMC Pregnancy and Childbirth. 2022;22(94):  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884...

8.         Douglas PS. Re-thinking benign inflammation of the lactating breast: classification, prevention, and management. Women's Health. 2021;18: doi: 10.1177/1745505

9.         Douglas PS. Re-thinking lactation-related nipple pain and damage. Women's Health. 2021:18:doi: 10.1177/17455057221087865.

10.       Douglas PS. Re-thinking benign inflammation of the lactating breast: a mechanobiological model. Women's Health. 2022;18: https://doi.org/10.1177/17455065221075907

11.       Douglas PS, Geddes DB. Practice-based interpretation of ultrasound studies leads the way to less pharmaceutical and surgical intervention for breastfeeding babies and more effective clinical support. Midwifery. 2018;58:145–155.

12.       Douglas PS, Miller Y, Bucetti A, Hill PS, Creedy DK. Preliminary evaluation of a primary care intervention for cry-fuss behaviours in the first 3− 4 months of life (‘The Possums Approach’): effects on cry-fuss behaviours and maternal mood. Australian journal of primary health. 2015 Mar 17;21(1):38-45.

13.       Douglas PS, Hill PS. A neurobiological model for cry-fuss problems in the first three to four months of life. Med Hypotheses. 2013;81:816-822

14.       Douglas P, Hill P. Managing infants who cry excessively in the first few months of life. Bmj. 2011 Dec 15;343.

15.       Fallon V, Groves R, Halford JC, Bennett KM, Harrold JA. Postpartum Anxiety and Infant-Feeding Outcomes: A Systematic Review. J Hum Lact. 2016.

16.       Tanganhito DD, Bick D, Chang YS. Breastfeeding experiences and perspectives among women with postnatal depression: a qualitative evidence synthesis. Women and Birth. 2020 May 1;33(3):231-9.

17.       Webber E, Benedict J. Postpartum depression: a multi-disciplinary approach to screening, management and breastfeeding support. Archives of psychiatric nursing. 2019 Jun 1;33(3):284-9.